Individual
SANDHRA THEKKUMTHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, GROUND RHOADS, PHILADELPHIA, PA 19104-4206
(215) 662-7355
Mailing address
3400 SPRUCE ST, GROUND RHOADS, PHILADELPHIA, PA 19104-4206
(215) 662-7355
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
UP006998C
PA
Other
Enumeration date
03/06/2013
Last updated
03/11/2013
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